Exploring Age and Sex Patterns for Rehabilitation Referrals After a Concussion: A Retrospective Analysis

Douglas N Martini; Jennifer Wilhelm; Lindsey Lee; Barbara H Brumbach; James Chesnutt; Paige Skorseth; Laurie A King

doi:10.1016/j.arrct.2022.100183

Exploring Age and Sex Patterns for Rehabilitation Referrals After a Concussion: A Retrospective Analysis

Arch Rehabil Res Clin Transl. 2022 Jan 31;4(2):100183. doi: 10.1016/j.arrct.2022.100183. eCollection 2022 Jun.

Authors

Douglas N Martini¹, Jennifer Wilhelm^{2

3}, Lindsey Lee^{2

3}, Barbara H Brumbach⁴, James Chesnutt^{2

5}, Paige Skorseth², Laurie A King^{2

3}

Affiliations

¹ Department of Kinesiology, University of Massachusetts Amherst, Amherst, Massachusetts.
² Department of Neurology, Oregon Health & Science University, Portland, Oregon.
³ National Center for Rehabilitative Auditory Research, Veterans Affairs Portland Healthcare System, Portland, Oregon.
⁴ Biostatistics and Design Program, Oregon Health & Science University, Portland, Oregon.
⁵ Departments of Family Medicine and Orthopedics & Rehabilitation, Oregon Health & Science University, Portland, Oregon, United States.

Abstract

Objective: To explore patterns of postconcussion care at a level 1 trauma center.

Design: Retrospective cohort study.

Setting: U.S. level 1 trauma center and local satellite units.

Participants: Patients of any age with a concussion diagnosis that reported to level 1 trauma center and local satellite units between 2016 and 2018 (N=2417).

Intervention: Not applicable.

Main outcome measures: Age, sex, point of entry, rehabilitation referrals, and pre-existing comorbidity diagnosis.

Results: Patient age (mean [SD]) significantly differed among points of entry, from youngest to oldest: 26.0 (14.0) years in sports medicine, 29.3 (23.0) years in the emergency department, 34.6 (23.6) years at primary care providers, and 46.0 (19.7) years at specialty care departments. Sex also significantly differed among points of entry; emergency departments reported more men (55.6%), whereas the other points of entry reported more women (59.3%-65.6%). Patients were more likely to receive a referral from sports medicine (odds ratio [OR]_unadjusted=75.05, P<.001), primary care providers (OR_unadjusted=7.98, P<.001), and specialty care departments (OR_unadjusted=7.62, P<.001) than from the emergency department. Women were more likely to receive a referral (OR_unadjusted=1.92, P<.0001), regardless of point of entry. Lastly, patients with a preexisting comorbidity were more likely (OR_adjusted=2.12, P<.001) to get a rehabilitation referral than patients without a comorbidity.

Conclusions: Point of entry, age, sex, and preexisting comorbidities are associated with postconcussion care rehabilitation referral patterns. Improving concussion education dissemination across all entry points of a level 1 trauma center may standardize the postconcussion rehabilitation referral patterns, potentially improving the time to recovery from a concussion.

Keywords: ADHD, attention deficit/hyperactivity disorder; Concussion education; ICD-10, International Classification of Diseases 10th Revision; LOC, loss of consciousness; Mild traumatic brain injury; OHSU, Oregon Health Science University; OR, odds ratio; OT, occupational therapy; PT, physical therapy; Psych, psychology; Rehabilitation; Rehabilitation care; ST, speech therapy; mTBI.